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The impact of mild-moderate hearing loss is bigger than you may think

mild hearing loss
Imagine in every conversation, you can hear bits and pieces of what is being said, but not the entire thing.

Instead of telling the person you cannot hear because you still can mostly hear, you enhance your focus and work to puzzle together the message being given to you. At first, it may not seem like a big deal, but could you imagine needing to be on high alert in every conversation in every moment of your life for a period of many years? Eventually, that will catch up to you.

My Background

My life has been spent hearing in the mild-moderate hearing loss range. I mostly did not wear hearing aids throughout my life. After close to 30 years of kind of hearing and kind of not hearing, I found my heart pounding in social situations. I liked being one-on-one with some people I was comfortable with, but I found myself avoiding social interactions with the general population. My brain was wrapped in brain fog, which made it more challenging to understand things on top of the hearing loss. The fog seems to be disappearing with learning ASL and wearing my hearing aids. While my hearing loss is not improving, my level of awareness is due to having access to proper resources.

I can often hear people one-on-one, but that can vary (deeper voices are more challenging). Unlike one-on-one situations, in groups, I often can’t give that direct feedback on whether I can understand. In the past, I was ashamed of my hearing loss, which made me try to hide it rather than be open about my needs. Because I didn’t understand everything I was missing, my responses would often not make sense to the other person. I have received negative feedback from others due to my responses on many occasions. For years, this bothered me inside, but nobody could actually see what I was feeling. I never analyzed it, so I never really understood what was going on, exactly. I didn’t really understand how hearing loss worked. Those around me seemed to understand even less. I have spent the last couple years studying hearing loss and trying to make sense of my situation. I thought I was alone in this, but I am coming to realize that this is a global issue; and because of that, I want to bring more awareness to this topic.

Why you may not notice mild-moderate hearing loss

Mild-moderate hearing losses are not as noticeable in the immediate moment, making them seen as less serious. Because of this, it can present a very confusing situation for both the speaker and the listener. On one hand, the person can hear sound and speech, but on the other hand, this person is not getting a clear picture of what is being said, according to Mark Ross’ book,  “Hard of hearing children in regular schools: with Diane Brackett and Antonia Maxon.”

Research states that “the mild and moderate classifications tend to imply that these levels of hearing loss do not pose a threat for the individual, when in fact all levels of hearing loss can present significant problems,” according to Alesia Howard’s unpublished master’s thesis at Gallaudet University, “Understanding hard of hearing identity.”

With this mindset, it can actually be more harmful to the person as they may never receive the supports they need for equal access to understanding.

Often times, the person with a milder loss doesn’t even think their loss is a big deal. Why is this?

Let’s look at how hearing loss works in a setting with just two people: Alice and Bob. Alice has mild-moderate hearing loss, while Bob has normal hearing. First, Alice might just miss bits and pieces of information in a louder setting. Then, she tends to use to the excuse: “Bob just likes to mumble.” Bob uses the excuse: “You weren’t paying attention” or: “You have selective hearing.” Neither party thinks it’s a big deal, initially. Maybe missing out on interactions only happens every once in a while. Maybe Alice can hear her partner just fine, because she has gotten used to his speaking style, but struggles with groups or out and about in the community. Either way, it doesn’t seriously impact the person’s life, right away, that is.

Social settings are affected too

The more social settings a person joins, the more they are at risk of missing out in conversations. With a milder hearing loss, I like to call this death by a thousand paper cuts. It doesn’t affect you the first several hundred times, but after a buildup of years and a variety of social settings, it can leave you behind academically and socially, causing disabling anxiety to a point where you go out of your way to avoid people and interactions.

Hard of hearing people often pick up coping mechanisms to adapt to their surroundings in the best way that they can. According to Howard, research shows that when a hard of hearing person doesn’t respond as predicted or properly, a person may not want to continue to socialize with the person. Over time, it can cause a person to feel misunderstood, which can cause mental health challenges. The longer this is not taken care of, the larger the buildup of challenges the person will need to overcome.

What happens to your brain with mild-moderate hearing loss?

Each person has a working memory, which is basically a scratchpad area in the brain that temporarily stores pieces of information while the brain is processing thoughts. Different parts of working memory handle different stimuli. There is one area that holds sounds, which is the auditory working memory (AWM).

Rinu Roy’s reported studies that showed that people with mild-moderate hearing loss have reduced capacity in the AWM. This affects one’s ability to recognize speech and without equal access to language, can contribute to learning disorders, according to Roy’s research thesis “Auditory Working Memory: A Comparison Study in Adults with Normal Hearing and Mild to Moderate Hearing Loss.” 

If the ears don’t have proper stimuli during a child’s development, then the capacity of the AWM is reduced. Even if only one ear receives fewer stimuli, it affects the brain processing of the signal from that ear. The upshot is that if you are not getting all the sound from outside the head all the way into the brain through both ears, then part of the brain which processes sound shrinks or doesn’t grow as much as it should, according to Roy.

Example of sounds heard without hearing loss

Example of sounds heard with mild hearing loss

Listening fatigue still exists

Hard of hearing individuals tend to be misunderstood because the ability to hear can fluctuate, depending on the situation. Situational factors such as environmental noise and distance can make hearing much more difficult. Sometimes the hearing loss itself fluctuates. In some situations, a hard of hearing person may be able to hear for a short time but not for an extended period, according to Howard.

They are working full time to understand what is being said, demanding more effort than what others are experiencing, causing them to become mentally drained in conversation. When a person is drained, they cannot put as much effort into piecing together conversation and can even appear uninterested in the conversation.

Children are affected more

A child with a hearing loss can have more difficulties than adults with the same loss, because the child does not have an established vocabulary to play the guessing game of fill-in-the-blanks. They are still acquiring a language, to begin with! Also, James Kauffman and Daniel Hallahan found that kids tend to imitate their peers, even if they do not understand what is happening, in their book “The illusion of full inclusion: a comprehensive critique of a current special education bandwagon.”

This can make it more challenging for the teacher to connect their behaviors to a hearing loss. I proposed an IEP plan for these students in a previous article.

Action Needed

Tell Your Story

We need more people to speak up about their experiences and we need more overall awareness to improve supports. It’s easy to let this go and move on, but the importance of speaking up is critical so that the next kid (or anybody for that matter) in a similar situation does not go through the same agony. Thus, I propose that every person with a hearing loss (yes, you!) share the challenges they have gone through to show this is a serious issue.

Raise Awareness about Mild-Moderate hearing loss

I am still today trying to figure out how to explain the seriousness of an untreated smaller hearing loss, in a way that most people will understand. From an outsider’s perspective, it can look like I am overreacting. But I am one of the few people that know how problematic this issue can be because I personally lived it. Learning more and educating others about hearing loss is important and a key to having an understanding of communication challenges.

Hearing aids

The majority of individuals in the world with a hearing loss fall into the mild range of loss. No hearing loss is too small to benefit from hearing aids. In fact, it is critical to use them for a clear understanding of spoken language. This helps compensate for the extra effort being used and helps makes conversation flow naturally.

ASL/Bilingualism

It is true that all hard of hearing people also benefit from American Sign Language. This is another way to gain full access to language and it also forms a community. When we are able to work together as a community, we can build stronger alliances and improve the supports for all of us. I truly believe bilingualism and community are the key for hard of hearing individuals to thrive.

Kayla DeGuire
Author Details
Kayla was diagnosed with hearing loss in first grade but is believed to have been hard of hearing since birth. After avoiding facing it for her entire life, she is learning to understand and truly love this part of herself at 33 years old. She has genetic progressive sensorineural hearing loss and wears Phonak Sky B-90 hearing aids. These are pediatric style hearing aids with colorful molds and she chose these because they are bold, colorful and fun (big kid at heart). She has dedicated the last four years to learning American Sign Language as she has fallen in love with the language and wants to utilize the language in whatever work she does, yet she’s exhausted from pushing herself so hard and taking a break to heal from her past and share her life stories. She feels very “in-between” worlds with a moderate-moderately severe hearing loss and is hoping to continuously learn how she can become a better advocate for people who have been on a similar journey. “I share my stories with advice of what has worked for me. One thing I have learned is what works for me may not work for somebody else. Our DHH communities are diverse and our wishes is something that should be respected and celebrated as it makes each of us safe to be ourselves in our own unique beautiful way.”
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Kayla DeGuire
Kayla was diagnosed with hearing loss in first grade but is believed to have been hard of hearing since birth. After avoiding facing it for her entire life, she is learning to understand and truly love this part of herself at 33 years old. She has genetic progressive sensorineural hearing loss and wears Phonak Sky B-90 hearing aids. These are pediatric style hearing aids with colorful molds and she chose these because they are bold, colorful and fun (big kid at heart). She has dedicated the last four years to learning American Sign Language as she has fallen in love with the language and wants to utilize the language in whatever work she does, yet she’s exhausted from pushing herself so hard and taking a break to heal from her past and share her life stories. She feels very “in-between” worlds with a moderate-moderately severe hearing loss and is hoping to continuously learn how she can become a better advocate for people who have been on a similar journey. “I share my stories with advice of what has worked for me. One thing I have learned is what works for me may not work for somebody else. Our DHH communities are diverse and our wishes is something that should be respected and celebrated as it makes each of us safe to be ourselves in our own unique beautiful way.”
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